Provider Demographics
NPI:1396384145
Name:RUEDEL, LAUREN (LMFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RUEDEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 FIELDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-2508
Mailing Address - Country:US
Mailing Address - Phone:502-718-2350
Mailing Address - Fax:
Practice Address - Street 1:7413 FIELDSTONE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-2508
Practice Address - Country:US
Practice Address - Phone:502-718-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty